Membership

Online registerform

I   
hereby apply for membership of the European Forum for Restorative Justice.

I apply for *:
Full membership (with voting rights)
Associate membership (without voting rights)

I would like to become a *:
Individual member, and I pay 40 Euro.
Local organisation member, and pay 120 Euro. I will send the required mandate to the Secretariat of the Forum.
Regional, national or international non-governmental organisation member, and pay 175 Euro. I will send the required mandate to the Secretariat of the Forum.
Regional, national or international governmental organisation member, and pay 600 Euro. I will send the required mandate to the Secretariat of the Forum.
(payment can only be made in Euro)

The membership fee will be paid by *:
Transfer to account number 431-1763651-37 (IBAN BE35 4310 7636 5137). The address of the bank is: KBC-Bank Leuven-Ladeuze, Ladeuzeplein 15-19, 3000 Leuven, Belgium. The swift- or BIC-code of the bank is: KREDBEBB.
VISA/MasterCard (in order to ensure the security of your VISA, you should fax the form on the next page)

My home address is:  
Street + number *:
Postal code *:
City *:
Country *:
Nationality *:
   
My work contact details are:  
Organisation *:
Function *:
Street + number *:
Postal code *:
City *:
Country *:
Telephone:
Alternative telephone:
Fax:
E-mail *:
Second e-mail:
Website:
   

I hereby state that I agree with the general aim of the European Forum for Restorative Justice
yes no